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Oct 03 05 11:26a Drew Van Allen 209r7-9668 p.1 <br /> DATE RECENED-- � ;� <br /> SAN OAQUIN COUNTY Et+O LOG NUMBER <br /> J <br /> . `1 J\ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org(ehd <br /> a,.. PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �c <br /> _ _ eUSINESSlAGENCY: �}i <br /> ADDRESS: a <br /> PHONE(1): Q4 PHONE 2 : ZoS GW- - � 133-'( <br /> ( ) FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: C- (� (oS O Y 30 <br /> Time: <br /> (Ploase allow 10 business days from date of appllcadon submittal-*Tentalive only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$ 3.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BLI (NESS DAYS <br /> SIGNATURE OF APPLICANT <br /> S7 —��-8 DATE <br /> UNITDlSTRIBUTON ❑ Unitl ❑Untt2 13 Lin Unitq Units ❑ UnitIS ❑ Other(electrwidlistamups) <br /> FILE ADDRESS <br /> Streets Street Name city EHD USE ONLY <br /> 1. Ito j :Do rq a S .�F �rc+cM CG E <br /> 2. t4-f <br /> 3. Zo5} t <br /> 4. (641 ctnq�'4r Wo S��K <br /> J)�. D U <br /> 6. ZyaZ D tt Nt.1.,{, S Ion <br /> 7. d3'J C�.p t�a,r vJe ?ut_Sr�c- <br /> 8. Sts Nx44- L ca+� S <br /> ,. <br /> c <br /> 9. 2oa5 Qv D✓'Ivt. 3{dt.K <br /> 1 D. Z.4 ,V_ Vci^ jiv rat 34. t K <br /> Specific Date Range of Information Requested:From 2; O'111 to C_Q <br /> y- ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> .4 UNDERGROUNOTANK(UST)CLEANUP SITE(LOP) ❑HOUsING ABATEMENT ❑SOLID WASTE FAMLITYNENICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOLIO FACILITY ❑WASTE TRE <br /> ❑UNDERGROUND TANK(MONTDMNGfREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CKCKEN RANCH ❑ NT <br /> WASTEWATER TREATMENT PLA <br /> ❑TPERMITIBD FAr]LnY ❑ MOTELOTEL ❑PUMPER TRUCKIYARO.ICHEM TOILET$ <br /> 13 TATTOTTO OIBODY PIERCING /H <br /> ❑ POOLISPA ❑LANO USE APPUCARON SITES <br /> ❑MMCAL WASTE FACII TY ❑OTHER(PLEASE SPECIFY} <br /> WELL AND SEPTC PERMIT RECORDS ARE AVAILABLE FOR RENEW• MONDAY.FRIDAY 8:00 AM-6:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted-for additional assistance with file addresses,contact <br /> the EHD.Applications received after 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHD 0424 E <br /> 1HNU5 <br />